Breast pain also known as mastalgia, ranges from mild to severe in intensity and can be constant, intermittent, or may only occur around menstruation. Most of the times, breast pain or mastalgia is due to fluctuations in hormone levels during the periods but there can be several other causes; from benign as cyclic breast pain to as lethal as breast cancer. Around 70% of females, all around the world report breast pain at some point during their lives but only rarely do they require treatment for it.
- Cyclical breast pain
- Non-cyclical breast pain
- Fibrocystic breast disease
- Pain during breastfeeding
- Breast pain caused by an abscess
- Breast cellulitis
- Menopausal breast soreness
- Painful breast lump
- Breast cyst
- Medication induced mastalgia
- Ill-fitted bra
- Breast cancer
1. Cyclical breast pain
Cyclical breast pain occurs 3 to 7 days before menstruation and improves at its onset. This is the most common cause of breast pain experienced by females in their reproductive ages. This usually affects the upper, outer quadrant of the breast but can cause pain anywhere else as well.
- Pain mostly affects the outer and upper part of the breast
- Pain also radiates in the arm
- Swollen and lumpy breast
- Severe discomfort
Drastic changes and major fluctuations in the reproductive hormones around the cycle are major causes of cyclical breast pain. Estrogen is responsible for the enlargement of breast ducts and progesterone causes swelling of milk glands, thus causing severe pain. Both these hormones increase during the second half of the menstrual cycle.
- Since the pain is only due to fluctuating hormone levels, conservative treatment is employed
- Evening primrose oil provides relief from the pain
- Breast support can be given with the use of a firm bra during the day and a soft bra at night
2. Non-cyclical breast pain
Non-cyclical breast pain comes and goes and is most common in postmenopausal women, who are not on estrogen replacement therapy. This can affect both breasts, can occur on one side, or may even affect a specific area. This type of pain is not related to the menstrual cycle, thus, can occur before or after menopause.
- Dull and heavy breast pain
- Tingling and burning sensation
- Lumpiness and severe discomfort
- Irritation associated with soreness
- Swelling of some degree
There is no specific cause of non-cyclical breast pain and may be due to lack of estrogen hormone, trauma, or history of falls. Some other causes are:
- Referred pain from the chest wall
- Pregnancy (first trimester usually)
- Non-steroidal pain relievers for severe pain
- Topical gel to be applied to the affected site
- A properly fitted bra for support
Inflammation of breast tissue is referred to as mastitis. This is a common complaint in lactating women but can also affect non-lactating and non-pregnant females due to an infected piercing or cracked nipple.
- Breast tenderness and pain
- Itching and redness
- Infected tissue has a slightly higher temperature than surrounding tissues.
- Fever and chills
- Pain extending to the armpit area
- Milk may contain blood, mucus, or pus
Milk ducts and glands can get blocked resulting in stasis of milk in the breast. Stagnant milk provides the breeding ground for bacteria that cause infection and inflammation leading to mastitis.
- Anti-inflammatory drugs relieve the inflammation
- Antibiotics are given to treat a bacterial infection
- Conventional treatment is given along with medication to relieve the symptoms
4. Fibrocystic breast disease
This is a benign breast condition that makes the breast tissue lumpy and nodular due to fibrosis and the formation of a cyst. Most women experience discomfort and mastalgia associated with fibrocystic changes.
- Feeling of lumps and knots in the breast
- Tenderness and pain
- Greenish brown discharge from nipples
- Thick or rubbery feeling in the breast
- Pain in the armpit
- Skin puckering
Fibrocystic changes are a result of fluctuating estrogen levels which are responsible for:
- Overgrowth of cells that line lactiferous ducts
- Adenosis of breast
- Fibrosis of the breast tissue
- Fluid-filled cyst formation
- Over the counter pain killers for excessive pain
- Topical progesterone gel
- Vitamin B6 as a long-term treatment
- Surgical excision and drainage of the cyst
5. Pain during breastfeeding
Mothers who breastfeed their babies often complain of breast pain. Most of the time the pain goes away without any sort of treatment while other times basic management is employed to relieve the discomfort.
- Breast tenderness and pain
- Sore or cracked nipples
- Breast heaviness
- Excessive lactation and leakage of milk
Engorgement of the breast due to excessive activity of glands and ducts during lactation to produce more milk may result in inflammation of the tissue. This is more common during the first few days, right after the delivery, as milk production is more as compared to the demand of the baby.
New mothers may fail to properly attach the baby which does not allow proper drainage of one of the segments of the breast. This eventually ends up in a clogged milk duct, leading to mastitis.
- Anti-inflammatory drugs for inflammation
- Antibiotics in case of an infection
- Breast massages while nursing to help with proper milk let down
- Other conservative measures can also help with the discomfort and pain
6. Breast pain caused by an abscess
A breast abscess is the most common complication of mastitis and is characterized by a puss-filled painful lump under the skin of the breast. It is more prevalent in lactating females.
- Tenderness at the point of inflammation
- Redness of skin
- Temperature is slightly hotter than the surrounding skin
- Mostly forms after Mastitis
Bacteria may enter the milk ducts and breast tissue by the pores in the nipples. This bacteria has favorable breeding grounds in form of a clogged duct and stagnant milk. White blood cells fight against these bacteria, causing tissue necrosis and accumulation of inflammatory mediators which form pus. The most common causative bacteria are staphylococcus aureus.
- Antibiotics for infection
- Antipyretic for fever
- Fine needle aspiration of the fluid from abscess smaller than 3 cm
- Incision and drainage of abscess larger than 3 cm
7. Breast cellulitis
Cellulitis is a bacterial infection that affects superficial skin and subcutaneous tissue. Breast cellulitis mostly occurs as a complication after surgery and mostly affects the lower half of the breast, later on dispersing and affecting the rest of the breast.
- Redness of skin
- Fast spreading rash
- Swollen breast
- Fever and chills
- The skin is warm and inflamed
- Cracks on the skin
Breast cellulitis is an opportunistic infection resulting due to stasis of lymphatic fluid. This allows profuse bacterial growth and thus infection and inflammation. The bacteria gain entry through cuts and cracks, surgical incisions, or radiotherapy of the breast.
- Antibacterials to resolve the ongoing infection
- Painkiller for mastalgia
- Over the counter ointments for pain relief
8. Menopausal breast soreness
Breast changes are among other prominent effects menopause has on a female’s body. Hormonal fluctuations in perimenopause cause soreness and tenderness in breast which is usually nothing to be worried about.
- Breast pain and tenderness
- Swollen breasts
- Changes in size and shape of the breast
- Hot flashes
- Vaginal dryness
- Decrease in libido
Lack of estrogen and progesterone during the perimenopausal phase, cause shrinkage of milk ducts and milk glands which causes soreness and tenderness in breast tissue.
Most of the time the pain subsides itself, but in case of severe discomfort and pain, these options can be availed:
- Over the counter pain relievers
- Topical analgesics
- Vitamin therapy with vitamin B and E
- Supplementation with Omega 3 fatty acids and fish oils
9. Painful breast lump
A breast lump can also cause pain and is an alarming sign. A breast lump needs immediate medical attention and a series of investigations to rule out the incidence of cancer.
- Tenderness and Pain due to Swelling
- Smooth or fluctuant to touch
- If the lump is an Abscess, it can be accompanied by fever
- The size and location of the lump may change with the menstrual cycle
Other than cancer, which is very rare, a lump can be caused by several different conditions, such as:
- Fibrocystic changes in the breast
- Breast cysts
- Symptomatic treatment is usually done
- The underlying cause is treated
10. Breast cyst
Cysts are fluid-filled sacs that develop under the skin. These can be individual or in the form of clusters. Breast cysts range from small, hardly noticeable to large, painful lumps.
- Breast tenderness and pain
- Feel like a bunch of grapes or a balloon filled with water just under the skin
- A nipple discharge
- Fever in case of infection such as mastitis or a breast abscess
Breast cysts appear in the glandular tissue of the breast due to several causes:
- Excessive production of estrogen stimulates cyst formation
- Blockage of milk ducts and milk stasis leading to infection and thus cyst formation
- Hormonal fluctuations
- Over the counter painkillers for pain relief
- Oral contraceptives for regulation of the menstrual cycle
- Fine needle aspiration of a large cyst to avoid progression of the infection
- Surgical excision and removal of a persistent cyst
11. Medication-induced mastalgia
Some medications are known to cause breast pain. Some of these drugs are steroids, anti-psychotics, anti-depressants, digoxin, methyldopa, and drugs for infertility treatments.
- Tenderness and pain
- Swelling or painful breast lumps
Discontinue using the causative medication and consult your physician for an alternative treatment option.
Referred pain from the chest wall or costo-sternal joint can be mistaken as breast pain. This is mostly due to arthritis and causes burning and numbness.
13. An ill-fitted bra
An ill-fitted bra that is either too tight or too loose can compress the breasts or leave them hanging improperly. This can cause severe discomfort and pain.
14. Breast cancer
Breast cancer does not cause pain, mostly. However, in later and more advanced stages an inflammatory cancer is painful and causes discomfort.
- Presence of newly formed lumps in the Breast
- Everted or inverted nipple
- Drastic weight loss
- Palpable lymph nodes in the axilla
- An abnormal, bloody discharge from the nipple
Treatment entirely depends upon the staging of cancer.
When to consult the doctor?
If you experience worsening of pain, the presence of new lumps, or lumps increasing in their size, a sudden increase in heaviness, you should not ignore any of these variations and book an appointment with your physician as early as possible.
What is the most common cause of breast pain?
The most common cause of breast pain in reproductive years is cyclical breast pain, which occurs due to fluctuating hormone levels in the body around the menstrual cycle.
Is breast pain indicative of cancer?
No, pain rarely is a symptom of cancer. Breast pain can be caused by a no of other causes.
Are both breasts equally and always affected?
The involvement of the breast depends upon the cause of pain. Hormonal fluctuations usually affect both breasts while other causes like mastitis, abscess, cellulitis, and trauma cause pain in just the affected side.